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17315 Studebaker Rd, Ste 110 Cerritos, CA, 90703 INTENSIVE CARE EXAMINATION
(CRITICAL CARE)
Date: _______________ Score __________________ 1. Michael is a 19 year old college student. Last week he suffered an MI. he was pledging to a fraternity and as part of the hazing ritual, he was required to consume large amount of alcohol. He passed out and the other members left him on the lawn outside to “sleep it off.” Michael became hypoxic and has a left anterior wall MI. He was unresponsive when found. Michael was in a third degree heart block when he was admitted to your unit and his 12 lead EKG showed primary lead change in V2-V4. Michael regained consciousness and was extubated on the fifth day post admit day and suffered no neurological deficits. Today, he complains of precordial pain that radiates to the shoulder and neck and is worse when he coughs or takes a deep breath. Michael probably is symptomatic of : A. An extending MI. B. A dissecting aortic aneurysm. C. Dressler’s syndrome. D. Pneumonitis. 2. Diana had influenza 2 weeks ago. She was admitted to you MICU because she had an exacerbation of her COPD. Today she started having difficulty with repeated headaches. When you return to her room after notifying the physician about the headache, you note that she is exhibiting a facial droop, yet her speech is clear. Because of her recent history, you suspect Guillain-Barre syndrome. What are the 4 types of Guillain-Barre syndrome? A. Ascending, progressive, relapsing-remitting, pure motor B. Ascending, descending, Miller-Fisher variant, pure motor C. Ascending, descending, relapsing, pure sensory D. Ascending, relapsing-remitting, pure motor, pure sensory. 3. Doris is a 30 year old admitted to you ICU with status asthmaticus. She has been taking Accolate, Allegra, and using a Proventil inhaler. Prior to her admission, Doris was coughing paroxysmally and hr bronchospasms worsened so she has transported to the ED. In the ED, she received albuterol, oxygen, and epinephrine without significant improvement. On auscultation, inspiratory and expiratory wheezing with a prolonged expiratory phase is heard throughout the lung fields. She is using accessory muscles for respiration and is tachycardia and tachypneic. She is placed on 2 L/min via NC and ABGs are drawn. Blood gas result show: pH 7.50. pO2 96 mm Hg, pCO2 28 mm Hg, and HCO3 23 mEq/L. these blood gas results showed repiratory alkalosis and Doris was placed on a mask at 5 L/min. her wheezing became less audible and her work of breathing increased. This probably indicates: A. Improvement. B. A need to lower the O2. C. A need for epinephrine. D. A worsening condition. 4. People who have emphysema develop chronic hypoxia. Which potential imbalance would be expected with this condition? A. Hypokalemia B. Hypochloremia C. Decreased bicarbonate levels D. Hyponatremia 5. Gerry was involve in a automobile accident and suffered multiple fractures and lacerations. He has been on TPN for nutritional needs. This morning he is confused and disoriented to place and time. he also exhibits orthostatic hypotension. The physician believes Gerry has HHNS. Which labs would you anticipate for a patient with HHNS? A. Glucose 1,258, negative ketones, serum osmolality 375 mOsm/L B. Glucose 550, positive ketones, serum osmolality 280 mOsm/L C. Glucose 700, negative ketones, serum osmolality 27 mOsm/L D. Glucose 600, positive ketones, serum osmolality 240 mOsm/L 6. You have just assisted with the insertion of an esophageal and gastric balloon. Tamponade therapy duration should be carefully documented because: A. Prolonged inflation may lead to necrosis or ulceration. B. Patient comfort increases 24 hours after balloon placement. C. Hgb and Hct should drop after balloon placement. D. Enteral feeding may be given via the tube after 36 hours. 7. Marco was preparing his family’s Sunday meal when he bumped a pan of boiling water and spilled it on his left arm. The burn on his left arm is pink and blistered. When it is touched, Marco screams with pain. This classification of burn is A. First degree. B. Second degree partial thickness. C. Third degree full thickness. D. Fourth degree full thickness. 8. Your patient was in full arrest following a root canal procedure. After a successful resuscitation, the patient has developed Ludwig’s angina. This type of angina can be defined as A. A type of painful Bradycardia in which the Q-T interval is lengthened. B. Cardiac ischemic post-code syndrome. C. Dysrhythmia with severe pain secondary to inhalation of noxious gases. D. An infectious process. 9. Acute post-hemorrhagic anemia develops after A. Rapid loss of erythrocytes. B. The spleen is damaged. C. Iron levels decrease by more than 15%. D. Bone marrow is damaged. 10. High blood viscosity and low oxygen tension are the cause of which of the following types of anemia? A. Pernicious B. Aplastic C. Sickle cell D. Hemolytic 11. You notice your patient’s hand spasming when the automatic blood pressure cuff inflates. When you attempt a manual blood pressure measurement, the same thing happens when you inflate the cuff to just part the systolic pressure. This carpopedal spasm is indicative of A. Hypokalemia B. Hyperphosphatemia C. Hypocalcemia D. Hypernatremia 12. What is the mean arterial pressure (MAP) for a patient with a blood pressure of 95/50, and a heart rate of 85, PAP 29/14, and PAOP of 13? A. 65 B. 1.9 C. 72 D. 3.5 13. Harold suffered a cardiac arrest at a panic. The family did not perform CPR, and the paramedics arrived 6 minutes after the arrest occurred. The patient was found in pulseless V-tach. Defibrillation was performed and CPR was continuous during transport to the ED. The patient was transferred to the ICU because of a bed shortage in the ED. The physician initiated hypothermic measures and administered vecuronium. This medication was used to A. Control ventricular dysrhythmias. B. Prevent shivering. C. Stop bleeding. D. Prevent metabolic acidosis. 14. Normal values for pulmonary artery pressures would be: A. PAS 30-40 mm Hg, PAD 20-25 mm Hg, PAM 25-30 mm Hg B. PAS 20-30 mm Hg, PAD 4-10 mm Hg, PAM 10-15 mm Hg C. PAS 10-20 mm Hg, PAD 6-12 mm Hg, PAM 8-10 mm Hg D. PAS 5-10 mm Hg, PAD 4-8 mm Hg, PAM 6-9 mm Hg 15. You are discussing herbal remedies at work when you are approached by a family member of your patient with Alzheimer’s disease who has been admitted with pneumonia. She asks if her mother would benefit from drinking Gingko Biloba at home once discharged because she had heard that it would decrease symptoms in early-stage Alzheimer’s. you tell her: A. “There is a lot of research, but nothing really supports its use.” B. “Sure, there are no interactions with other drugs, so she should be fine.” C. “Her doctor doesn’t approve of any natural remedies, so don’t tell him if you are using it.” D. “There could be very dangerous side effects if this herb is taken without consulting her physician. I will have him speak with you when he comes in.” 16. Jonathan was admitted in hypertensive crisis. He has been receiving nitroprusside. As a critical care nurse, you know that when giving this medication, it is necessary to monitor for A. Tachycardia. B. Cyanide toxicity. C. Retinal changes. D. Ataxia. 17. Paula works in the fashion industry and is a cutter in the wool sweater section of her company. This morning, a fire broke out in her section. Paula did not suffer any burns, but did inhale large quantities of smoke. What would be the most potent toxin she might have inhaled? A. Carbon monoxide. B. Smoke. C. Inhaled nitrates. D. Cyanide. 18. Your patient was stabbed during a gang fight in the right anterior chest and left shoulder area. He lost approximately 1,500 to 1,600 mL of blood. Which of the following signs and symptoms would be expected with this volume of blood loss? A. BP decreased, pulse pressure normal, RR 20-30/min B. BP normal, RR increased, capillary refill normal C. RR increased, BP normal, pulse pressure normal D. BP decreased, RR increased, CO decreased 19. Which of the following conditions would be contraindicated when scheduling a patient for a transesophageal echocardiogram (TEE)? A. Cardiac tumors B. Dysphagia C. Vegetative endocarditis D. Mitral valve regurgitation 20. What must be present for calcium to be utilized by the body? A. Increased oral calcium B. Increased phosphorus C. Euthyroid state D. Adequate vitamin D levels

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Relato de caso - ref. 094-05 - transplante autologo.versão 3- corrigida.p65

Silva RL et al Rev. bras. hematol. hemoter. 2006; 28 (2):153-156 Transplante autólogo de células-tronco hematopoiéticas sem uso de hemocomponentes Hematopoietic stem cell transplantation without the use of blood transfusions O transplante de células-tronco hematopoéticas (TCTH) é terapia consolidada paratratamento de algumas doenças onco-hematológicas, e o suporte transfusional

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